3-drug combination stabilizes new onset of type-2 diabetes

eMaxHealth ^ | June 25, 2013 | Kathleen Blanchard RN

[neverdem]

A new study shows patients newly diagnosed with type-2 diabetes fare better when they are given a 3-drug combination compared to conventional therapy with one anti-diabetic medication.

The finding that comes from researchers at University of Texas Health Science Center at San Antonio was presented June 22 at the 73rd Scientific Sessions of the American Diabetes Association in Chicago.

Ralph DeFronzo, M.D., chief of the Diabetes Division in the School of Medicine at The University of Texas Health Science Center at San Antonio presented findings from a two-year study that included 134 participants at the University Health System's Texas Diabetes Institute.

The 3 drug combination given in the study included consists of metformin, pioglitazone - a newer class of medication for type 2 diabetes - and exenatide, which is a glucagon-like peptide or GLP-1 agonist. An example is the drug Byetta.

Usual treatment is to start patients with new onset of diabetes on the drug metformin; then add a drug in the sulfonylurea class that stimulates release of insulin from the pancreas and next insulin, based on response to blood sugar control.

Examples of sulfonylurea drugs include Glucatrol, Amaryl, Diabeta and Micronase. In addition to helping the beta cells in the pancreas produce more insulin the anti-diabetic drugs help the body’s cells use insulin more efficiently.

DeFronzo explains the 3-drugs used in the study for diabetes helped preserve beta cells in the pancreas.

Each has a different target that corrects two deficits associated with type-2 diabetes – the body’s inability to respond better to the hormone insulin and decreased insulin production from beta cells in the pancreas.

The goal of the therapy the researchers say was to prevent weight gain that happens easily with other anti-diabetic drugs, keep hemoglobin A1c (HbA1c) levels normal that in turn prevents complications of blindness, kidney and blood vessel disease and prevent blood sugar levels from fluctuating.

DeFronzo reported the triple therapy for diabetes:

• Kept HgA1c levels on average at 6.0, compared to 6.6 in group receiving conventional therapy. The maximum level recommended by the ADA and the European Association for Study of Diabetes is 6.5.
• Compared to 42 percent participants receiving conventional therapy, just 17 percent of those given the 3 drugs failed to reach hemoglobin A1c level goal of 6.5.
• Diabetics given the triple therapy had normal blood sugars at home consistently. Those given conventional therapy had wide fluctuations outside the range of normal.
• Conventional therapy for diabetes was associated with 8 to 9 pound weight gain after 2-years, compared to 2 to 3 pounds of weight loss for newly diagnosed diabetic patients given the 3-drug combination.
• Forty-six of patients given conventional therapy had at least one episode of hypoglycemia or low blood sugar, compared to fifteen percent of patients on triple therapy.

The 3 medications studied for new onset type-2 diabetes may not be right for every patient because of side effects that should be discussed with your doctor or pharmacist. "These drugs are not cures, but patients are basically normal while taking them," Dr. DeFronzo said in a press release.”

[Pining_4_TX]

The results show that the drugs reduce the numbers. They do not show that this results in a reduction in long-term complications, which is what is really important.

Doctors and the FDA are starting to question this approach. The studies necessary to show meaningful results from taking these drugs would have to last decades. Obviously, the drug companies prefer the current system where they just have to show that the surrogate markers of the disease, the numbers, improve.

When you consider that every drug has side effects, and that the more drugs you take, the greater the risk, it would make sense to proceed with caution.

[neverdem]

When you consider that every drug has side effects, and that the more drugs you take, the greater the risk, it would make sense to proceed with caution.

While I'm inclined to look for adverse drug reactions, they are usually dose related. They are probably starting this 3-drug combination with the lowest dose of each drug because hypoglycemia is a definite fear.

I've seen a low dose multiple drug approach recommended for high blood pressure also to avoid adverse drug reactions.

I believe in treating patients, not numbers, but if you have bad outcomes, and the patient's numbers are really bad, and the doc didn't try to correct those numbers, the doc might get sued for malpractice.

[Pining_4_TX]

The fear of lawsuits and a lack of alternatives is precisely why Americans are taking too many prescription drugs.

The combination of lowering the threshhold for what is considered to be bad and the aging population means that it won’t be long before 90% of us are considered to be sick with something, and thus in need of pills.

I highly recommend the book Rethinking Aging: Growing Old and Living Well in an Overtreated Society by Nortin Hadler, MD. I personally know of a number of people who were harmed by too many tests, pills, and/or surgeries. Doctors have forgotten the beginning of their oath, “First, do no harm.”

[Some Fat Guy in L.A.]

Metformin kills my gut.

Mine too at first but I got used to it - took a couple of months.

[Petruchio]

My T2-D was out of control. When I started chemo for cancer my Insulin use went from insane to outrageous. Someone sent me the following link:

http://www.vitamindcouncil.org/about-vitamin-d/vitamin-d-and-other-vitamins-and-minerals/

After reviewing the info with my team of Doctors I added 4 of the supplements to my daily diet.

Results:
My Fasting BS with 150IU Levemir 2X/Day was 275 - 300.

Now my Fasting BS with NO added Insulin is 140 - 160.

Note: My BS still goes sky high during Chemo infusion weeks because of the steroids, but that is expected. I am working with my Doctors to recalculate my Insulin dosing for both steroid and non-steroid days..

YMMV. Talk to your DR. FIRST.